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Introduction Limited data are available about the outcomes of transcatheter mitral valve replacement (TMVR) using transseptal approach in patients with prior mitral valve repair (valve‐in‐ring) or replacement (valve‐in‐valve) (TMViVR) and on modes of the prior surgical valve failures. We report our tertiary center TMVR experience in high surgical risk patients with prior mitral valve repair or replacement. Methods From December 2016 to January 2020, patients with symptomatic severe mitral valve stenosis and/or insufficiency at increased redo surgical risk were included. TMViVR was performed off‐label with Sapien S3 valve (Edwards Lifesciences). Patients were followed within 30‐days and 1‐year from the procedure. Results Twenty‐seven patients underwent transcatheter mitral valve‐in‐valve (n = 21) or valve‐in‐ring (n = 6) replacement. Mean ± SD age was 71.8 ± 11 years with Society of Thoracic Surgeons’ calculated mortality 7.1 ± 4.6%. The etiology of valve failure was stenosis in 17 (63%) patients, insufficiency in 4 (14.8%) patients, and both in 6 (22.2%) patients. TMViVR technical success was 100% in all patients. Left ventricular outflow track (LVOT) obstruction was observed in only one (3.7%) patient. Zero patients had moderate or severe central mitral valve regurgitation or paravalvular leak. All patients had symptomatic improvement at 30 days. The mean transmitral diastolic pressure gradient decreased from 14.1 ± 4.6 to 6.9 ± 4.6 mm Hg (p < .001) at 30 days. The one patient with LOVT obstruction required readmission at 5‐months. One‐year survival was 95%. At 1‐year mean gradients remained lower than the baseline (7.0 ± 3.0 vs. 12.4 ± 4.0, p = .002). Conclusions Transcatheter mitral valve‐in‐valve and valve‐in‐ring replacement is feasible and safe. The improvement in mitral valve hemodynamics appears to be durable.

Background: Monitored Anesthesia Care (MAC) has been increasingly used in lieu of general anesthesia (GA) for transcatheter aortic valve replacement (TAVR). We sought to compare outcomes and in-hospital costs between MAC and GA for TAVR at a single center Veterans Affairs Medical Center. Methods: A single-center retrospective review of 349 patients who underwent TAVR (MAC, n = 244 vs. GA, n = 105) from January 2014 to December 2019 was performed. Baseline patient characteristics, operating room (OR) time, intensive care unit (ICU) length of stay (LOS) and cost, total LOS, hospital cost, total cost, and complication rates were collected. Propensity matching was performed and resulted in 83 matched pairs. Results: In the unmatched TAVR cohort, MAC TAVR was associated with reduced OR time (146 vs. 198 minutes, P < .0001), ICU LOS (1.4 vs. 1.8 days, P < 0.0001), total hospital LOS (3.4 vs. 5.4 days, P < .0001), and lower index total cost ($81,3000 vs. $85,400, P = .010). After propensity matching, MAC TAVR patients had reduced OR time (146 vs. 196 minutes, P < 0.05), ICU LOS (1.2 vs. 1.7 days, P = .006), total LOS (3.5 vs. 5.1 days, P = .001), and 180-day mortality (2.4% vs. 12%, P < 0.03). There was no difference in total hospitalization cost or total cost. Conclusions: In propensity matched groups, TAVR utilizing MAC is associated with improved OR time efficiency, decreased LOS, and a reduction in 180-day mortality, but no significant difference in cost.